North Cumbria out of hours service provider - CHOC (Cumbria Health On Call)
- Use the special patient form to ensure your patients details are entered on the CHOC computer.
- Update details regularly (and please inform CHOC of any deaths).
- CHOC cars carry the following kit in a box in the boot.
An OOH Palliative Care Kit, carried by each car. (Same kit is available in CHOC treatment centres)
- Syringe Driver kit with giving set and spare batteries.
- Information sheets on doses for syringe drivers and instructions on use of syringe driver.
- Midazolam injection (and its antidote flumazenil).
- Hysocine hydrobromide injection.
- Haloperidol injection.
- Metoclopramide injection.
- Cyclizine injection.
- Levomepromazine injection.
- Dexamethasone tablets and injection.
- Water for injection 10mls.
- Haloperidol 1.5mg tablets and hyoscine tablets.
NO INJECTABLE MORPHINE OR DIAMORPHINE IS CARRIED IN THE KIT. Any patient likely to need more than 50mg of morphine/24 i.e. on more than 50mg 12h modified release morphine orally needs a pro-active plan for morphine or diamorphine supply at the end of life. Options are:
- 1. To prescibe morphine or diamorphine pro-actively on a named patient basis and leave it in the house.
- 2. To have arrangements with the local pharmacists.
- 3. To use the on call emergency retail pharmacy system.
- 4. For CHOC doctors doing a shift to call CHOC control and ask to activate the out of hours scheme to access higher doses of morphine or diamorphine.
- In a real emergency, the on-call pharmacy service for North Cumbria Acute Hospitals NHS Trust will do its best to provide a supply.
All apart from option 1 lead to delays for patient and family at a potentially very distressing time, so think hard about pro-active prescribing.
- All CHOC cars have a palliative care manual, and instructions for setting up a syringe driver. From July 2004, all car will carry a copy of "Palliative care for the Primary Health Care Team" as a resource.
- CHOC opening hours and locations
Palliative care communication pack 1 updated June 2009